Pharmacist intervention in colorectal cancer screening initiative

Abstract

Objectives: To assess the novel approach of using the community pharmacist as the primary health care team member to facilitate colorectal cancer (CRC) risk counseling and screening in socioeconomically disadvantaged populations.

Setting: A collaborative effort between the UConn Health Colon Cancer Prevention Program and UConn School of Pharmacy in conjunction with large independent chain pharmacies (medium to medium-high volume) located in metropolitan areas of Connecticut, including Hartford, Bridgeport, New Haven, and Stamford. Pharmacies located in hospitals, across the street from a large physician practice, or within the community.

Practice description: The study involved 2 phases. The first phase involved education and training for community pharmacists regarding counseling approaches for patients on the topic of CRC. The second phase of the study involved patient recruitment and counseling with subsequent fecal immunohistochemical testing (FIT).

Practice innovation: A community pharmacist provided face-to-face counseling on CRC risk factor reduction and provided CRC screening to patients who were without insurance or underinsured. No CRC screening or education program existed beforehand.

Evaluation: A target sample size of 60 participants was needed with a type 1 error rate of 5% and a power of 80%. Exploration of variables using multivariate logistic regression model included any variable with a univariate P < 0.2. Multivariate P values < 0.05 were considered independent predictors.

Results: After approaching 312 consumers, 16 of them consented to the study. The majority of participants (88%) were African American or Latino, and 69% were currently unemployed. Eight participants agreed to complete FIT, and 88% of participants completed FIT correctly. Only 1 positive FIT result was observed, but a subsequent colonoscopy was negative. Of the 12 questions that assessed baseline CRC knowledge in the initial survey, 16 participants answered an average of 2.6 (range, 0-6, SD, 1.6) questions incorrectly. Only 4 participants completed the follow-up survey of CRC knowledge and program satisfaction; thus, exploration of variables was not conducted. Patients indicated high satisfaction with the program of education and FIT dispensing.

Conclusion: This study faced difficulty in recruiting pharmacists to participate, with the main reason being lack of compensation and disruption to workflow. Patient participation in the trial was also low because of a lack of time or interest in participation. Of the patients who did participate, the level of satisfaction in having the pharmacist speak to them about CRC screening was high. This service is an excellent example of how the pharmacist can provide a more accessible, convenient, and responsive approach to patients' needs while improving health equity. Future studies that employ a revenue model to build the infrastructure and capacity necessary to offer this service efficiently and consistently are needed.